Basic Information
| Provider Information | |||||||||
| NPI: | 1003241019 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHEAST FLORIDA EYE CARE ADDOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11406 SAN JOSE BLVD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322237963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042603839 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4413 TOWN CENTER PKWY | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322468568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9049989822 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2013 | ||||||||
| LastUpdateDate: | 09/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9045454465 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.